Strengthening Global Health Security by implementation of the International Health Regulations (IHR) (2005) and the Global Health Security Agenda in Nigeria

Nigeria has a projected estimated population size of 203,452,505 (July 2018), which makes Nigeria the most populous nation in Africa. The country's National Health Act 2014 (NHA 2014) was signed into law on October 31, 2014 and provides a legal framework for the regulation and management of Nigeria's national health system, however, much work is needed to operationalize the law. Monitoring and mitigating recurring infectious disease outbreaks, as well as detecting and controlling emerging infectious diseases, will be impacted by multiple factors that include inadequate surveillance and response systems, weakened or non-existent infrastructure and health systems and poor coordination among stakeholder agencies. Nigeria is a major gateway to many global destinations. In July 2014, the index case in the Nigeria Ebola Virus disease outbreak arrived at the international airport in Lagos, Nigeria. This index patient potentially exposed 72 persons at the airport and the hospital where he was admitted. The Federal Ministry of Health (FMoH), with guidance from the Nigeria Centre for Disease Control (NCDC), declared an Ebola emergency and rapidly implemented a response using all available public health assets and resources. An Ebola Incident Management Center (a precursor to the current Emergency Operations Center) was established to rapidly respond to the 2014 outbreak. Using an Incident Management System (IMS) to coordinate the response and consolidate decision making, largely contributed to helping contain the Nigeria outbreak early. In 2017, the WHO Joint External Evaluation (JEE) of International Health Regulations (2005) core capacities, a voluntary, collaborative and multi sectoral process to assess the country's capacity to prevent, detect and rapidly respond to public health risks, was conducted in Nigeria. Findings from the JEE highlighted strengths and weaknesses that currently exist in preparedness and response to public health emergencies in Nigeria across 19 technical areas. A National Action Plan for Health Security (NAPHS), a 5-year strategic plan developed collaboratively with relevant Ministries, Departments and Agencies (MDAs) in Nigeria and based on the principles of One Health', was developed in 2019 and seeks to strengthen IHR core capacities based on gaps identified by the JEE and other health security assessments conducted in Nigeria. The NAPHS covers all the 19 technical areas of the JEE required to effectively prevent, detect, and respond to public health threats. The JEE exercise identified the priorities for the improvement and development of Nigeria's health security capacities as follows: The passage and implementation of the NCDC Bill;The establishment of a multi-sectoral One Health coordination mechanism at Federal, State, and LGA levels;Strengthening of laboratory capacity;Scaling up implementation of the integrated disease surveillance and response (IDSR) program;Development and implementation of a comprehensive public health workforce strategy;Enhancing the EOC/incident management system at the federal level and strengthening sub-national rapid response teams;Designation of points of entry